Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital.

Purpose Improving access to care is an issue at the forefront of reproductive medicine. We sought to describe how one academic center, set in the background of a large and diverse metropolitan city, cares for patients with extremely limited access to reproductive specialists.

The NYU Reproductive Endocrinology and Infertility (REI) Fellowship program provides a “fellow-run clinic” within Manhattan’s Bellevue Hospital Center, which is led by the REI fellows and supervised by the REI attendings of the NYU Langone Health system. A description of the history of the hospital as well as the logistics of the fertility clinic is provided as a logistical template for implementation.

The fellow-run fertility clinic at Bellevue hospital is held on two half days per month seeing approximately 150 new patients per year. The fertility workup, counseling, surgery, as well as ovulation induction, and early pregnancy management are offered within the construct of the fellowship and residency at NYU. Barriers to care and ways to circumvent those barriers are discussed in detail.

By utilizing the ambition and construct of the OB/GYN programs, we greatly improve care for an otherwise underserved patient population by offering an efficient and optimal infertility workup and treatment in a population that would otherwise be without care. We utilize the framework of graduate medical education to provide autonomy, experience, and mentorship to both residents and fellows in our programs in an effort to provide a solution to combating inequity in infertility care. Similar content being viewed by others

Nachtigall RD. International disparities in access to infertility services. Fertil Steril. 2006;85:871–5. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK & Mathews TJ. Births: final data for 2015. National Vital Statistics Reports. 2017; 66(1): 1–69. Accessed May 20th, 2018. ASRM Committee Opinion #589. Female age-related fertility decline. Fertil Steril. 2014;101(3):633–4. Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: data from the national survey of family growth 1982–2010. National Health Statistics Report. 2014. Becker G, Castrillo M, Jackson R, Nachtigall RD. Infertility among low-income Latinos. Fertil Steril. 2006;85:882–7. Deka P, Sarma S. Psychological aspects of infertility. Br J Med Pract. 2010;3:a336. Andrew FM, Abbey A, Halman LJ. Is fertility-problem stress different? The dynamics of stress in fertile and infertile couples. Fertility and Sterility. 1992;57:1247–53. Luk BH, Loke AY. The impact of infertility on the psychological well-being, marital relationships, sexual relationships, quality of life of couples: a systematic review. J Sex Marital Ther. 2014;41(6):610–25. Che Y, Cleland J. Infertility in Shanghai: prevalence, treatment seeking and impact. J Obstet Gynaecol. 2002;22:643–8. Reproductive Medicine Associate of New Jersey. Trends in infertility 2017: Survey and Report. Accessed June 6th, 2018. Harris JA, Menke MN, Haefner JK, Moniz MH, Perumalswami CR. Geographic access to assisted reproductive technology health care in the United States: a population-based cross-sectional study. Fertil Steril. 2017;107(4):1023–7. Reindollar RH. Increasing access to infertility care – what will it take? Fertil Steril. 2017;108(4):600–1. https://www.reproductivefacts.org/resources/state-infertility-insurance-laws/?_ga=2.10876404.1736123632.1534617281-26038372.1532203552. Accessed January 19th, 2020. Herndon CN, Anaya Y, Noel M, Cakmak H, Cedars MI. Outcomes from a university-based low-cost in vitro fertilization program providing access to care for a low-resource socioculturally diverse urban community. Fertil Steril. 2017;108(4):642–9. Oshinsky D. Bellevue: three centuries of medicine and mayhem at America’s most storied hospital: Doubleday Press; 2016. Gold D. Bellevue: a documentary of a large metropolitan hospital. New York: Harper & Row. 1975; p. 409. Nychealthandhospitals.org. Accessed May 20th, 2018. Knopman JM, Talebian S, Fino ME, Kump L, Quagliarello J, Keegan DA. Fertility treatment in a public health care system in New York City: a description of Bellevue Hospital Center (BHC) reproductive endocrinology and infertility (REI) clinic. Fertil Steril. 2008;90:S153. Holzman GB, Downing SM, Power ML, Williams SB, Carpentieri A, Schulkin J. Resident performance on the council on resident education in obstetrics and gynecology (CREOG) in-training examinations: years 1996-2002. Am J Obstet Gynecol. 2004;191:359–63. Goldman KN, Tiegs AW, Uquillas K, Nachtigall M, Fino ME, Winkel AF, et al. Interactive case-based learning improves resident knowledge and confidence in reproductive endocrinology and infertility. Gynecol Endocrinol. 2017;33(6):496–9. Ombelet W, Campo R. Affordable IVF for developing countries. Reprod BioMed Online. 2007;15(3):257–65. Ombelet W. Reproductive healthcare systems should include accessible infertility diagnosis and treatment: an important challenge for resource-poor countries. Int J Gynecol Obstet. 2009;106(2):168–71. Herndon CN, Anaya Y, Noel M, Cakmak H, Cedars MI. Outcomes from a university-based low-cost in vitro fertilization program providing access to care for a low-resource socioculturally diverse urban community. Fertil Steril. 2017;108(4):642–9. Paulson RJ, Fauser BCJM, Vuong LTN, Doody K. Can we modify assisted reproductive technology practice to broaden reproductive care access? Fertil Steril. 2016;105(5):1138–43. Inhorn MC, Patrizio P. Infertility care around the globe: new thinking on gender, reproductive technolgoies and global movements in the 21st century. Hum Reprod Update. 2015;21(4):411–26. Doody KJ, Broome EJ, Doody KM. Comparing blastocyst quality and live birth rates of intravaginal culture using INVOcell to traditional in vitro incubation in a randomized open-label prospective controlled trial. J Assist Reprod Genet. 2016;33(4):495–500. Ombelet W. Is global access to infertility care realistic? The walking egg project. Reprod BioMed Online. 2014;28:267–72. Inhorn MC, Patrizio P. Is lower quality clinical care ethically justifiable for patients residing in areas with infrastructure deficits? AMA J Ethics. 2018;20(3):228–37. Inhorn MC. The new Arab man: emergent masculinities, technologies, and Islam in the Middle East. Princeton: Princeton University Press; 2012. Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009;91:2281–94. Boivin J, Buting L, Collins JA, et al. International estimates of infertility prevalence and treatment need and demand for infertility medical care. Hum Reprod. 2007;22(6):1506–12. Acknowledgments The authors gratefully acknowledge the patients and staff at the Bellevue Hospital Center. Author information Authors and Affiliations Contributions All authors contributed to the manuscript. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in this study were in accordance with the ethical standards of the institution. Informed consent There were no human subjects as part of this manuscript and therefore no need for informed consent. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Blakemore, J.K., Maxwell, S.M., Hodes-Wertz, B. et al. Access to infertility care in a low-resource setting: bridging the gap through resident and fellow education in a New York City public hospital. J Assist Reprod Genet 37, 1545–1552 (2020). https://doi.org/10.1007/s10815-020-01781-y Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10815-020-01781-y